Kelly Eye Center Post-Surgery Questionnaire Question Title * 1. How would you rate your distance vision? Poor Disappointing Neutral Good Excellent Poor Disappointing Neutral Good Excellent OK Question Title * 2. How would you rate your night vision? Poor Disappointing Neutral Good Excellent Poor Disappointing Neutral Good Excellent OK Question Title * 3. Do you ever wear glasses? Yes No OK Question Title * 4. When do you wear glasses? Distance vision activities (examples: driving, watching TV or movies, sporting events, etc.) Intermediate vision activities (examples: computer, cooking, email, gardening, etc.) Near vision activities (examples: reading, sewing, using cellphone, applying makeup, knitting, etc.) OK Question Title * 5. How often do your wear glasses? Always Sometimes Never OK Question Title * 6. If you had to do it again, would you make the same lens choice for your eyes? Yes No OK Question Title * 7. How would you rate your overall experience with Kelly Eye Center? Poor Disappointing Neutral Good Excellent Poor Disappointing Neutral Good Excellent OK Question Title * 8. Your Name and Additional comments: OK DONE